What is repigmentation by autologous melanocyte transplantation?

In this procedure for vitiligo cure, the normal melanocytes of the patient are harvested from his own normal skin, cultured in a medium and transferred to grow on the vitiligo affected area of skin.
In this repigmentation procedure there is least chance for the rejection of the transplanted melanocytes by his skin and complete cure can be achieved.

Not all vitiligo patients can get cure from this repigmentation surgery.
In active and progressive vitiligo, cure cannot be contemplated as fresh areas of skin keep losing melanocytes.
If the vitiligo is stable and nonprogressive for more than a year then this procedure of autologous melanocyte transplantation can be considered.
Vitiligo cure is possible with repigmentation by autologous transplantation in patients with focal or segmental vitiligo.
The affected area of skin must not be extensive as normal donor skin is required for the culture of the melanocytes transplantation.
In patients with Koebner phenomenon, vitiligo cure is not possible as linear depigmentation may start after the autologous transplantation.
Patients with keloid tendency and collagen disorder cannot undergo autologous repigmentation for cure of vitiligo, as keloid scars can develop at the sites of autologous melanocyte transplantation.
Patients with infections, especially of skin have to be treated and totally free of the ailment to be considered for this vitiligo cure.
In this melanocyte transplantation for repigmentation, a strict selection of the candidates for the procedure and a long pretreatment observation is necessary to prevent failures.

After anaesthetising the donor skin area of the patient a thin layer of 5-10 sq.cm of epidermis layer of skin is removed (excellent results with silver skin graft knife).
Care must be taken not injure the dermis, as injury to the dermis can cause scars at the donor site.
Alternatively an electric vacuum suction pump can be used to cause a blister at the donor skin area and the top of the blister is removed.
This epidermis layer is incubated for about one hour in trypsin and if any pieces dermis present is separated from the epidermis.
The epidermis is made into very small pieces and kept in the culture medium for further growth before the autologous melanocytes transplantation.
The culture is centrifuged to separate out the melanocytes.
Alternatively the separated melanocytes can be directly transplanted without further culture.
The vitiligo patch is prepared for autologous transplantation surgery and local anaesthesia is given.
Dermabrasion is done with laser or micromotor and the epidermis is removed.
Care must be taken not to injure dermis layer as injury to dermis may cause scars and cure by autologous repigmentation can get affected.
After the removal of epidermis, the melanocyte suspension is uniformly applied over the exposed dermis layer and the wound is covered with dressing of collagen.
The dressing is removed after a week. The treated patch may appear pink when the dressing is removed.
In about a month, repigmentation will start. The repigmentation covers up the entire area in four months.
In some patients another visit is required for achieving 100% pigmentation and cure.

Advantages of vitiligo cure with repigmentation by autologous transplantation

For vitiligo cure with autologous repigmentation hospitalization is not required.
In most of the cases near 100% results are seen.
Autologous repigmentation can be done on any area of the body.
Larger areas can be covered with melanocyte transplantation with small patches of epidermis; Aesthetic appearance is regained.
Normally no scars are caused in vitiligo cure with repigmentation by autologous melanocyte transplantation.

What is micropigmentation?

The repigmentation of the skin can be done by the procedure called micropigmentation (camouflage tattoo) in cases wherein the other treatments have failed or the responses have been poor.
Vitiligo micropigmentation is usually done on facial skin and other smaller skin areas to improve the aesthetic appearance of the affected person.

In this vitiligo camouflage micropigmentation technique artificial pigments are implanted into the skin uniformly, by using special surgical tattoo equipments. The pigment particles must be metabolically inert so that after completion of tattoo, the micropigmentation areas of skin do not get change in the pigments due to biological processes.

Colors like black, white (titanium oxide), camel yellow, brown (iron oxide), red (mercuric sulphate, cinnabar) are used in vitiligo camouflage. In sterile environment the colors are mixed and blended to get a very close match to the skin colour of the patient. Sterile water and glycerine are added to get a paste of this pigment powder.
The expertise, experience and training of the professional play a great part in the success of this scientific vitiligo tattoo procedure.

Requirements for skin micropigmentation

Both hand held mechanical pin vice or electrically operated machine can be used.

Pin vice to hold 8-10 needles is selected. If it is electrically operated device, needle bar with 2-6 needles is prefered.

Antiseptic lotion is required to clean the skin area where tattoo camouflage is to be done.

Local anaesthesia is required, so that the person undergoing micropigmentation will not feel pain or distressed.

High quality pigments and base materials are required.

For micropigmentation surgical bed with proper lighting is required.

Oral and topical antibiotics and anti-inflammatory medicines are required.

Suitability of patient for vitiligo micropigmentation

Patient with focal and non progressive vitiligo (for the past one year) is suitable for skin micropigmentation.

Micropigmentation is contraindicated in patients with progressive vitiligo.

This skin camouflage vitiligo tattoo may not be done on a person with HIV as the affected area may throw up more problems to the patient like infections especially of herpes simplex virus.

Vitiligo camouflage tattoo is also contraindicated in persons with collagen disorder and keloid tendency.

The vitiligo camouflage is also contra indicated if the person is suffering from any infectious disease and particularly of skin.

In such persons the procedure may be done after total cure and resolution of the skin infection and after proper evaluation of the present skin condition of the patient by a dermatologist.

Persons with medical history of psoriasis and skin allergies must consult a dermatologist before opting for vitiligo tattoo camouflage.

Procedure of vitiligo camouflage tattoo

As in any surgical procedure, the consent of the patient is taken for camouflage tattoo.

The machines and the equipment to be used for micropigmentation are sterilized properly.

The site of the skin wherein camouflage micropigmentation is to be done is surgically prepared.

The right blend of pigments for tattoo for getting a color very close to the colour of surrounding skin is made.

This is of vital importance as in improper blending the patient may end up with different tattoo color patches.

The pigment paste is applied on the vitaligo area and tattoo is done.

After completion the excess pigment is wiped off and the area is carefully observed for vitaligo spots wherein the pigment is not sufficiently implanted.

These areas are again applied with the pigment paste and tattooed to achieve uniform pigmentation.

To reduce inflammation cold sponge is pressed on the spot for some time.

Antibiotic and anti-inflammatory medicines are given to ward of infection and reduce inflammation and pain.

Advantage of vitiligo camouflage tattoo

In micropigmentation immediate camouflage of the vitiligo white skin patch is seen.

Compared to other vitiligo procedures, camouflage is less expensive.

In other procedures there may be poor response to the treatment while in vitiligo tattoo mostly satisfactory results are obtained.

In tattoo camouflage procedure hospitalisation is not required and the patient can return home after micropigmentation.

Camouflage micropigmentation can be done at any affected part of body.

Possible complications and side effects in vitiligo micropigmentation camouflage

In some persons this tattoo procedure may induce allergic reactions.

After all the care taken for matching the color of the normal skin with the tattoo pigment, sometimes there may be mismatches in some cases of micropigmentation.

Sometime there may be leaching of the pigment making the micropigmentation area look pale.

Visual and physical examination for diagnosis of leukoderma.

Irregular white patches of skin, especially on sunlight exposed ares of body such as hands, feet, arms and face can make the doctor to suspect the possibility of leukoderma.

The prominence of skin depigmentation on the face particularly around mouth, eyes, nostrils and ears and also around the other orifices of the body like umbilicus, anal opening and genital opening could be the indicator of leucoderma disease.

Physical examination white patches is also done to look for the presence of other depigmentation diseases, dermatitis and psoriasis.

Analysis of medical history for the diagnosis of leukoderma

The medical history of the patient is analysed.

If the patient suffers premature greying of hair, the white patches could be vitiligo.

In a patient having family history of leukoderma in near blood relatives this depigmentation may be leukoderma.

If the patient had in the recent past sunburn, burn injury, physical or mental stress or illness there is a likelihood of these white patches turning out to be vitiligo.

Patients with the medical history of sun sensitivity or autoimmune diseases are likely to get this depigmentation disease.

Laboratory tests and differential diagnosis of leukoderma

Laboratory tests are carried out to differentiate and diagnose this white patches disease.

Samples from the vitiligo suspected areas are taken and examined under microscope. Depigmentation affected area will be devoid of melanin producing cells (melanocytes).

If inflamed cells are observed in the sample, the white patches of depigmentation could be due to some other underlying cause.

KOH test is done to rule out fungal infections being the cause of depigmentation.

As in many cases vitiligo is associated to hyperthyroidism or pernicious anemia, blood test is carried to check the possibility of the presence of these conditions.

Blood test is done to check for the presence of autoimmune disease by looking for the antinuclear antibodies.

Sometimes inflammation of the eye occurs in vitiligo patients. Eye examination of the patient is done to look for possibility.

In the diagnosis if these white patches of skin are proved to be leukoderma, various options for treating this skin depigmentation have to be considered.

There are a number of possible causes for the onset of the disease. This disorder of white patches is believed to be primarily brought about by an autoimmune disease.

Autoimmunity causes vitiligo disorder

The most strong and accepted view about the causes of loss of pigmentation is autoimmunity.
In an autoimmune disease an individual's immune system reacts and destroys his own organs and body tissues.

In vitiligo disorder, the immune system produces certain proteins known as cytokines (immunomodulating agents) which target and alter the pigment producing melanocytes and leads to their gradual death resulting in white skin patches. There is another view that some autoimmune factor causes the self destruction of melanocytes and loss of pigment.

Persons already affected by other autoimmune disorders like psoriasis, rheumatoid arthritis and thyroid disease have the greater risk of loss of pigmentation.
The autoimmune disease of the adrenal glands (Addison's disease) has been associated with the occurrence of this disorder.
Thyroid disorder causes the disease with white patches having no pigment.
Inflammatory and autoimmune diseases of thyroid glands lead to their over expression or under expression.

Persons with this thyroid impairment have been found prone to loss of pigment.

Hereditary factors in loss of pigment

Strong evidence is pointing towards inheritance in persons whose close blood relatives already have this disorder.
There is a great possibility of children of the vitiligo affected parents developing this white patches.
It has been found that 30% of the persons affected by this disorder have at least one family member affected by the disorder of loss of skin pigment.
Individuals with vitiligo pigment disorder seem to inherit a batch of multiple genes which make them susceptible to loss of pigmentation.

Vitiligo affected hand

Physiological conditions and stress like sun burn and skin injury sometimes seem to be one of the causes for white patches.
Psychological stress triggers and leads to loss of pigment.
Environmental factors can also be the reason for white vitiligo patches.

Vitiligo is a skin disorder or disease in which there is loss of skin pigment resulting in white depigmentation patches.

What is vitiligo (leucoderma or leukoderma)?

Our skin color is due to the melanin pigment present in it. The melanin pigment is produced by specialised cells in the epidermis called melanocytes.
The melanin pigment is formed into bundles called melanosomes and deposited in the epidermis. Due to some physiological conditions there is stoppage of pigment production or death and loss of the pigment producing cells in patches and white areas of depigmentation occur. This condition of loss of pigmentation is called vitiligo (leucoderma or leukoderma).

Causes for vitiligo disorder

Though the basic cause of this disease is the depigmentation of the skin there are divergent views, theories and research results pointing to many possible factors like physiological conditions, hereditary disorders, genetic disorders, environmental factors, thyroid disorders, psychological stress and autoimmune diseases. For more details about the causes read the page ' causes for vitiligo disorders'.

Who can be affected by this condition of depigmentation?

Worldwide it is estimated that this condition of loss of skin pigment is affecting 1-2% of the population. This disease affects all races and both genders and appears prominent in dark skinned people. Persons with autoimmune disease and thyroid disorder are prone to get vitiligo disorder. The chances for the immediate relatives of an affected person to get this disorder are greater.

Patterns and types of vitiligo disease

Three types of this loss of skin pigmentation, namely focal, segmental and nonsegmental vitiligo are observed. In the focal form of the disorder, the white patches are restricted to one or a few areas. In non-segmented form the white patches appear on both sides and somewhat show symmetry. These white patches of skin grow over a period of time to spread all over the body. If the depigmentation is total or only a few pigment patches remain, the condition is called as vitiligo universalis. Segmental vitiligo disease affects younger individuals. The disorder affects some parts of the body and may not appear in symmetry.

Diagnosis of white skin patches

Vitiligo disease appear as white skin patches around orifices of the body like mouth, nostrils, eyes etc. They also appear on the end of the limbs like fingers and toes. These white patches are irregular in shape and keep growing in most of the affected persons. For more detail about diagnosis of the disorder read 'Diagnosis of vitiligo disease'.

Therapy and treatment for vitiligo skin disease

There is a difference between the approach towards this disorder between the western medicine and the oriental medicine. In oriental medicine the claim is that it is addressing the underlying cause of the disease. There are number of ways to alter the appearance in the vitiligo skin disease affected. The white vitiligo disease patches can be hidden by application of camouflage creams and skin dyes. Further treatment methods for the disease like topical application, oral medicine, phototherapy, surgical grafts, repigmentation and treatment with melanocyte cultures are possible. For detail information on treatment of this disorder read the page "Therapy and treatment of vitiligo disease".

Psychological and aesthetic aspects of the disorder of loss of skin pigment

Though this disease has no harmful effects on the body, it devastates the mental health of the affected person leading him to mood and depression disorders.
The loss of aesthetic appearance and being stigmatised for the condition ruins the self-esteem and emotional health of the person affected by the disorder. Those affected by this disease are tormented sub-consciously about others reactions, feel ashamed, embarrassed and dejected and may become introverts.

Support groups for the vitiligo disease affected

Considering the psychological impact of this disorder all over the world, a number of organisations have come up to help out the affected by educating them and providing them advice, counsel and course of treatment for the disease. These efforts are to save the affected from becoming a burden on the society just because of this harmless skin condition.

Research on pigmentation, depigmentation and repigmentation of this skin disorder

Wide spread research is going on to tackle this disorder. Methods for repigmentation of these white skin patches are already known and further research is going on . If the vitiligo disorder has affected more than 50% area, a process for depigmentation of the rest of the skin pigment is now known. Further research is being carried out in this aspect of tackling vitiligo disease.

Tuesday, January 5

Home › White spots and patches on skin
These are the most common skin problems faced by all of us at least at some point in our life. Pigmentation of the human body and the skin colouration is genetic and hereditary.

In some persons this mechanism goes haywire leading to white or dark spots and patches.
These disorders of skin may be due to deficiency of vitamins, genetic factors, infections, damage to skin by injuries, autoimmunity and many unknown factors.

Avitaminosis (vitamin deficiency disease)
The deficiency of B complex vitamins, especially vitamin B12 is found to lead to white spots and patches on the skin. With supplementation of the vitamins this condition is cured.

Pityriasis alba
This facial skin disorder of white spots and patches normally affect children, more often boys.Initially this appears as small round or oval white spots and these grow and merge to form white patches. Good nutritious food and stress free life seems to improve the skin health and rid it of the disorder. These may affect other parts of the body also. Usually these disappear after sometime.

Vitiligo (leucoderma)
Vitiligo is non contagious skin disorder giving rise to white spots and patches on the skin. Autoimmunity is the primary cause for vitiligo white spots and patches. Melanocytes, the pigment producing cells in the body get killed by immune cells, the reason for which is not known. These vitiligo patches may disappear in some persons and may also grow to cover much of the body in others. About 1-2% of human population suffers from this disorder.
In some families vitiligo is seen as a hereditary factor. In some persons, old skin injuries may also turn into vitiligo white patches.Recent advancements in treatment and surgery have opened the door of hope for vitiligo affected persons.

Milia (milk spots or oil seeds)
Milia (milk spots) are small cysts filled with keratin appearing on the mouth roof, genitalia, nose and eyes as raised white spots and are harmless. In children they may disappear after sometime, were as in adults if required they have to be removed.

Fordyce spots
These are pale or white spots and appear on the genitals and the lips. These white spots are sebaceous glands without hair follicle association (ectopic sebaceous gland). These white spots are harmless and are of cosmetic concern only. They respond well with acne treatments.

Skin DamageSkin damage due to injuries, burns and infections can lead to white patches on skin. These white spots are due to loss of melanocytes, the pigment producing cells.This depigmentation can be corrected to great extend with chemo and laser therapy.

White spots on skin from tanning beds
The pressure points where the body is supported while lying down has decreased circulation. These points may develop white spots and patches due to insufficient tanning. By shifting position regularly during tanning these white patches can be avoided. In person with skin infection the infected regions of the skin may tan less and develop into white patches.

Nevus depigmentosus
This hypo-pigmentation skin order is noticed in many cases right from birth. These white spots and patches are non contagious, harmless and stable and considered as birthmarks.

Idiopathic guttate hypomelanosis
It is presumed that this could be genetic disorder of the skin and it can give rise to white spots or patches on it.Especially persons with tanned skin show prominent white spots and patches if they are affected.

Tinea versicolor
White spots and patches on skin may appear due to infection of the skin by yeast (Malassezia furfur and M.globosa). Though these yeast are normally present in our skin they become problematic under certain conditions like warmth and humidity. These white spots on skin are round, oval or irregularly shaped, growing and merging to form large patches. This disease usually affects the back and the chest, though it may appear on any part of the body. In fair skinned people they appear as lighter spots and in dark skinned people they appear as dark spots. There can be extreme pin-prick itching on the spots. Prolonged treatment is necessary with antifungal application to control and cure it.

Leprosy
Leprosy in the early stages is diagnosed by the presence of a few white spots on the skin which are numb, pale and shining when compared to the surrounding skin. These white spots are due to the body's immune response to contain the infection and in the process, the melanocytes (pigment producing cells) also get killed giving rise to white spots and patches. White spots and patches lacking sensation require immediate medical attention.

There are three causes for whitening or white spots on the finger nails.Total whitening of the fingernail may occur in case of kidney failure, liver failure, protein malabsorption and as side effect of certain drugs like sulphonamides.Partial whitening or discolouration in bands occurs on physical injury to nail, chemotherapy and cirrhosis.The most common form is the appearance small white spots on the fingernail due to small injuries to the nail matrix. These white spots will move away from the base and get clipped in two months of time.If the white spots are on several fingernails and keep appearing freshly, it may indicate the deficiency of the trace mineral zinc. They will disappear on taking zinc supplements.

White spots on teeth
White spots on teeth occur due to dental fluorosis which in turn is caused by excessive exposure to fluorides. Children between 3 months to 8 years of age are the most affected.

Thrush (candidiasis)
Yeast infection of the mouth is called oral thrush and it appears as white patches inside the mouth and tongue. Mostly infants, elderly persons, sick persons and persons suffering from indigestion get thrush. Antifungal applications and mouthwashes may cure thrush.

LeukoplakiaIn this condition white spots and patches appear due to excessive growth of cells in mouth and tongue. In very rare cases these raised white spots or patches may become malignant (cancerous).

Oral lichen planusWhite Spots on Fingernails (Leukonychia)
These white spots or lines appear on the tongue as a network and the cause is not yet known. Mostly they disappear by after some time. Maintaining oral hygiene will help in resolving the condition.

White patches on tonsilsThese patches on tonsils are formed due to infections. Treatment with antibiotics and applications can cure in most of the situations. In chronic cases surgical removal of tonsils (tonsillectomy) is recommended.

Tonsil stone (tonsillolith)This is a white calcareous matter formed at the tonsillar crypts sometimes protruding. They are usually harmless and may cause bad breath. They fall off usually and they can also be removed.

Albinism
Albinism is a genetic trait caused by recessive genes. The whole body including eyes and hair lack melanin pigment. This skin disorder being hereditary has no cure. The skin of albinos get easily sunburned. Sun poisoning may also occur fast and the skin may turn reddish in reaction. Eyes cannot tolerate bright light as they are lacking pigment to filter it.

Leucism
Leucism is skin development disorder characterised by hypopigmentation caused by reduction in all pigments. This may also appear as white patches. The eyes may appear normal. In fetal development, defects in pigment cell differentiation and /or migration from neural crest to hair or skin result in leucism.

For related information on skin inflammation (dermatitis), white spots and skin sensitivity read the following posts.

The causes for Idiopathic guttate hypomelanosis are not exactly known but for its treatment and cure, differential diagnosis has to be done to exclude similar looking disorders.

The exact causes for the appearance of idiopathic guttate hypomelanosis white spots are still under investigation.

Idiopathic guttate hypomelanosis causes

As these white spots appear on the exposed parts of the body it presumed that the exposure to sunlight could be the cause for their appearance. Idiopathic guttate hypomelanosis appear on most exposed parts of the body like the shin, forearms, shoulders and neck indicating that sun exposure as the likely cause of their appearance.These white spots appear in the late twenties in some cases but their prevalence is from the early thirties onwards; the concurrent reason could be due the aging process. In young children and adolescents these white spots are very rarely seen; another indication that the aging process and sun exposure are the main causes.One of the reason is being light-skinned as these hypomelanosis lesions are rarely seen in darker skinned individuals.Idiopathic guttate hypomelanosis causes white spots in more number of women than men in the thirties and later on both the genders get equally affected.In some cases the disorder seem to run in families genetic tendency and inheritance seemed to be one of the causes for these white spots.

Idiopathic guttate hypomelanosis symptoms

The macules are small in size usually between 2 to 5 mm; one of the important symptoms.

In very rare instances size up to 10 mm is encountered.

The lesions are flat and are discrete, circular, oval or angular in shape.

They usually affect light-skinned individuals; another important symptom.

They appear on the sun exposed parts.

Hypomelanosis macules usually appear first on the legs.

Differential diagnosis of idiopathic guttate hypomelanosis

The macules first appear on the legs and later on forearms.
Diagnosis: excludes flat warts, Pityriasis alba and pityriasis versicolor.

These white spots are discrete and do not show darker border. The lesions are small in size and in very rare cases may reach a diameter of 10 mm.
Diagnosis: excludes vitiligo.

The lesions do not lose sensitivity.
Diagnosis: excludes leprosy lesions.

In rare instances histological studies are required for the diagnosis of idiopathic guttate hypomelanosis white spots.

Even if treatment is carried out fresh white spots may keep appearing at new areas.For individuals conscious about aesthetic appearance cure is available.

Idiopathic guttate hypomelanosis treatment with retinoids

Retinoids like tretinoin have been used with some success in removing guttate hypomelanosis. Tretinoin is the acidic form of vitamin A and it should be used with caution by people with sensitive skin as it can cause redness, burning and itching. To avoid these problems the frequency of application must be increased slowly. Tretinoin applied hypomelanosis lesions can get severe sunburn and exposure of these areas to sunlight must be avoided.Topical corticosteroids have been found to alleviate the white spots condition to some extent.

Dermabrasion or microdermabrasion may also be considered in the treatment of this disorder.These procedures must be done by a trained Aesthetician or a dermatologist as improper therapy may leave greater scar marks. Dermabrasion is a painful process to be done under general or light anesthesia. Microdermabrasion is not very painful and can be done at cosmetic spas.

Idiopathic guttate hypomelanosis treatment by cryotherapy and surgery

Cryosurgery or cryotherapy also have been tried successfully. In this method of therapy white spots are frozen resulting in the death of thin layer of skin at the affected area. Soon the normal skin takes over and cover-up the dead skin and the white spots disappear.Surgical removal of the affected skin and grafting of the healthy skin has been successful.
Although these procedures may remove the current hypomelanosis, there is no treatment to stop fresh lesions from appearing.

Idiopathic guttate hypomelanosis on leg

Hence it is advised to tackle the root cause. Sun tanning and tanning beds may be avoided by young fair-skinned individuals, especially young women, to prevent possible idiopathic guttate hypomelanosis white spots at a later life.